Introduction Previous studies including Welsh National Audit on management of Broncholitis have stimulated interest to assess appropriateness of CXR requests within Welsh paediatric departments. Basic standards of advice exist for bronchiolitis, viral induced wheeze and community acquired pneumonia. The current usage of CXR’s needs to be explored and appropriateness evaluated.

Aims To audit appropriateness of CXR requests in children presenting with bronchiolitis, community acquired pneumonia or viral induced wheeze, against national guidelines.

Methods Prospective observational study performed from 13^th October to 13^th November 2014, across general paediatric departments in Wales. Structured questionnaires completed, with questions based upon: CXR request reasons, clinical diagnosis pre CXR and management plan pre and post CXR.

Results 9 hospitals participated. A total of 183 cases received, 76 of these were omitted as request reasons were outside the project remit, leaving a total of 107 cases. Table 2 illustrates the reasons for CXR requests. 16% of chest radiographs performed were indicated as per national guidance. Chest radiographs did not alter clinical management in 98% nor alter clinical diagnosis in 100%.

Conclusions A unique study involving CXR requests in doctors practising across Wales. This study highlights the overuse of chest radiographs as when used inappropriately do not alter clinical diagnosis or management. This has cost and radiation implications for the paediatric population. We recommend a quality improvement project aiming to decrease numbers of unnecessary CXR’s requested in general paediatric departments across Wales.